How Do Somatic Obsessions Affect Body Awareness in OCD?

What you need to know

• Somatic OCD involves intrusive awareness of bodily processes like breathing or heartbeat
• This can lead to distressing experiences of organs feeling “intrusive” or demanding constant attention
• The author distinguishes between “tactility obsessions” involving sensing organs and “motility obsessions” involving controlling bodily movements

Background on Somatic OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform. While OCD can manifest in many ways, this paper focuses on a subtype called somatic OCD.

In somatic OCD, a person becomes excessively aware of and distressed by normal bodily processes or sensations. Common examples include:

• Breathing
• Blinking
• Swallowing
• Heartbeat
• Body positioning
• Visual phenomena like “eye floaters”

For instance, someone might become intensely focused on their breathing to the point that it feels unnatural or difficult. They may worry that if they don’t consciously control their breathing, they’ll stop breathing altogether. This leads to significant anxiety and preoccupation with the bodily process.

Importantly, in somatic OCD these aren’t just passing concerns - they become time-consuming, distressing fixations that interfere with daily life. The person often recognizes their fears are excessive but feels unable to shift their attention away from the bodily sensation.

A New Framework for Understanding Somatic Obsessions

The author of this paper, Joni Puranen, proposes a new way of conceptualizing somatic obsessions based on how we experience our internal organs and bodily processes. He suggests two main categories:

1. Tactility obsessions - Focused on sensing organs/processes
2. Motility obsessions - Focused on controlling bodily movements

To illustrate this framework, Puranen analyzes three organs: the liver, heart, and lungs. This comparison reveals important differences in how we perceive and interact with our internal organs.

The Liver: Hidden from Awareness

The liver serves as an example of an organ that typically remains outside of our conscious awareness. Under normal circumstances:

• We don’t feel our liver’s presence or movements
• We can’t voluntarily control liver functions
• It operates automatically without our input

Because of this, the liver doesn’t tend to be a focus of somatic obsessions. We simply don’t have the same tactile awareness or ability to control it compared to other organs.

The Heart: Tactile but Not Controllable

The heart represents a different case:

• We can often feel our heartbeat, especially during exercise or stress
• We can indirectly influence heart rate through activity or relaxation
• But we can’t directly control the heart’s contractions voluntarily

In somatic OCD, a person might become fixated on sensing their heartbeat. They feel trapped by constant awareness of this rhythmic sensation. This exemplifies what Puranen calls a “tactility obsession” - the intrusive feeling of an organ that we can sense but not directly control.

The Lungs: Both Felt and Controllable

Breathing and lung function occupy a unique position:

• We can feel the sensations of breathing
• Breathing usually happens automatically
• But we can also voluntarily control our breath

This combination of features makes breathing a common focus in somatic OCD. A person may feel compelled to consciously control their breathing, fearing that if they don’t, they’ll stop breathing. This represents a “motility obsession” in Puranen’s framework.

The Lived Experience of Somatic Obsessions

Puranen argues that to truly understand somatic OCD, we need to look beyond just the thought patterns involved. The actual bodily sensations and feelings of intrusion are central to the experience.

Tactility Obsessions

In a tactility obsession like hyper-awareness of heartbeat, the person experiences:

• A shift from the heart being “silent” and unnoticed to demanding attention
• Feeling trapped by constant awareness of the heartbeat sensation
• A sense of the heart as an “intruder” in one’s own body
• Difficulty shifting attention away from the sensation

It’s not just anxious thoughts about the heart, but the actual felt experience of the heartbeat that becomes all-consuming.

Motility Obsessions

With a motility obsession like breathing fixation, additional factors come into play:

• Disruption of the usual automatic nature of breathing
• Feeling responsible for manually controlling breath
• Fear of dire consequences (suffocation, death) if attention lapses
• Physical discomfort from altered breathing patterns

The person feels trapped between:

1. The ability to control breathing voluntarily
2. The constant need to breathe to survive

This creates an exhausting cycle of hyper-vigilance and attempted control over a normally automatic process.

Conclusions

• Somatic OCD involves more than just distorted thoughts - it fundamentally alters how a person experiences their own body
• Distinguishing between tactility and motility obsessions helps clarify the different ways organs can feel intrusive
• The lived, felt experience of bodily intrusion is central to understanding somatic OCD
• This framework may help inform more targeted treatments that address the embodied nature of somatic obsessions

By examining somatic OCD through the lens of how we sense and control our organs, we gain new insights into this challenging condition. This perspective highlights the complex interplay between mind and body in OCD, moving beyond a purely cognitive understanding. Further research in this direction may lead to more effective, body-aware approaches to treating somatic obsessions.